Treating ADHD and Aggression

Posted on December 26, 2013 at 3:47 pm

According to researchers at the Ohio State University Wexner Medical Center, prescribing two drugs—a stimulant and an antipsychotic—to children with physical aggression and attention-deficit/hyperactivity disorder (ADHD) can reduce aggressive behavioral problems.[1] The combination of drugs should be coupled with teaching parents behavior management techniques for their children.1

Director of Clinical Trials, Michael Aman, Ph.D., states, “Combination pharmacotherapy is becoming common in child and adolescent psychiatry, but there has been little research evaluating it. Our findings may be considered somewhat controversial because they appear to support the use of two drugs over one for treating children with aggression and disruptive behavior when things do not seem to be going well. Many practitioners have been taught to keep things simple and safe in their medical training. In general this is good advice.”1

The Treatment of Severe Childhood Aggression (TOSCA) study included 168 children between the ages of six and 12 who were diagnosed with ADHD and displayed significant physical aggression.1 The participants were divided into two groups.1 Both received the psychostimulant drug OROS (brand name Concerta) and their parents received behavioral parent training for nine weeks.1 This treatment combination is basic, as both are evidence-based and have shown to be helpful in improving ADHD and aggression.1 Group One received a second medicine on top of that, the antipsychotic drug risperidone, and Group Two received a placebo.1

Group One showed significant improvement on the Nisonger Child Behavior Rating Form (NCBRF).1 While there is always a risk adding a second drug, the two combined seemed to neutralize some of each other’s potential side effects.1 For example, the children in Group One did not have trouble falling asleep once the risperidone was added.1

“We conducted this study because we viewed the combination of ADHD and significant physical aggression as a serious situation,” Aman said. “It is not uncommon to use more than one medicine for other serious situations, such as when treating cancer or epilepsy, for instance. Although doctors have often used stimulants and antipsychotics together in recent years, we did not have good evidence until now that they would work more effectively when carefully staged and given together.”1